摘要
目的评价心功能-内分泌-细胞因子这一潜在系统在慢性心衰(CHF)发病中的作用,以及苯那普利对该系统的作用。方法50例伴有心率>90bpm的CHF患者分为B组与M组,分别使用苯那普利(5～10mg/d)及美托洛尔(12.5～50mg/d)治疗,根据血压及心率调整剂量,疗程8周。观察两组治疗前后心衰相关指标的变化。结果①心功能:治疗后收缩压(SBP)、舒张压(DBP)及心率(HR)均有不同程度的下降,其中B组的SBP下降明显,M组的HR下降明显,组间差异均有统计学意义(P<0.05)。治疗后两组患者的NYHA分级呈不同程度下降,以B组明显(Z=-2.078,P=0.038)。治疗后患者左心室收缩末期直径(LVESd)有所减小,左室射血分数(LVEF%)及舒张早/晚期心室充盈速度峰值比(E/A)有所升高,均以B组明显(P<0.05);②心脏内分泌指标:治疗后血浆心钠肽(ABP)及脑钠肽(BNP)均有所下降,仍以B组明显;③细胞因子:治疗后血清转化生长因子β1(TGF-β1)及白介素1β(IL-1β)的变化情况与内分泌指标相同,以B组明显(P<0.05);④相关性分析显示ANP、BNP、TGF-β1与IL-1β四者两两呈正相关性(相关系数C>0.850,P<0.01);LVEF%与以上四者均呈负相关性(均│C│>0.80,均P<0.05)。结论心功能-内分泌-细胞因子这一系统可能在CHF发病机制中起到重要作用,苯那普利治疗伴有心率加快CHF的临床疗效优于美托洛尔,前者可能是通过上述机制起效的。
Objective To explore the role of the potential regulatory system -cardiac function-internal secretion-serum cytokines in the mechanism of chronic heart failure （CHF）. Methods 50 CHF patients with heart rates more than 90 bpm were divided into two groups：group B and M,and treated with benazepril（5～10mg/d）and metoprolol （12.5～50mg/d）,respectively and for 8wks. The indexes related to the cardiac function were compared. Results ①Cardiac function：systolic and diastolic blood pressure （SBP,DBP） and heart rates （HR） decreased after a 8wks treatment and SBP in group B was lower whereas HR in group M （P〈0.05）. The cardiac function graded by NYHA were improved,which was more apparent in group B when compared with group M （Z=-2.078,P=0.038）.About the ultrasound cardiogram,the LVESd lessened but LVEF% increased,which was also more significant in group B. ②Cardiac internal secretion：Atrial natriuretic peptides （ANP） and brain natriuretic peptides （BNP） decreased after treatment,which were also more significant in group B. ③ Serum cytokines：trans-forming growth factor β1 （TGF-β1） and interleukin 1β （IL-1β） changes like ANP and BNP （P〈0.05）. ④Pearson correlation analysis indicated that any two of the four factors-ANP,BNP,TGF-β1 and IL-1β presented positive relation （C〉0.850,P 〈0.01）. Besides,there was negative relation of LVEF% and any two of the four factors （│C│〉0.800,P〈0.05）. Conclusion Regulatory system of ＂cardiac function-internal secretion-serum cytokines ＂ maybe play a key role in CHF and benazepril might improve the cardiac function by regulate the expression of internal secretion （ANP,BNP） and serum cytokines such as TGF-β1 and IL-1β.
出处
《中国现代医药杂志》
2010年第5期26-29,共4页
Modern Medicine Journal of China
关键词
慢性心衰
心功能
细胞因子
苯那普利
美托洛尔
Chronic heart failure Cardiac function Cytokines Benazepril Metoprolol
